Provider Demographics
NPI:1033740832
Name:ALCORN, MARK D (RPH)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:ALCORN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2998 ROCK CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MINERAL WELLS
Mailing Address - State:TX
Mailing Address - Zip Code:76067-2524
Mailing Address - Country:US
Mailing Address - Phone:940-452-3467
Mailing Address - Fax:
Practice Address - Street 1:1702 SANTA FE DR
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-6420
Practice Address - Country:US
Practice Address - Phone:817-594-3435
Practice Address - Fax:817-594-7772
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19411183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist